I've been working in the pharmaceutical and research industry for 20+ years and am familiar with most sides of thought about healthcare reform. One troubling aspect of Obamacare that doesn't seem to be getting any discussion however is the very issue that caused much of Hillary Clinton's efforts at reform to crumble. Its the thorny issue of privacy.

Ms. Clinton envisioned unique identifiers for Patients, Physicians, Providers and Payers, all of the players in our current healthcare system.  Our current HIPAA regulations were the outcome of this standardized set of identifiers, except everyone balked at the Patient level.  Docs and Insurance and healthcare providers all loved the new regulations and standardization because it helped them streamline paperwork and get paid sooner.  It was all about the backend money part of the loop - not about health care.

But having a unique, lifelong identifier for every patient in the system is a very real concern.  VP Biden is now pushing $1.9b of Obamacare money to implement electronic medical records in hospitals, with $500m of that dedicated to develop systems to transport that info anywhere.  The idea is that you could walk into a hospital in Denver and have your appendix removed, and then drive to New York and check into a hospital a year later and the docs would have "instant" access to your health records.

But this means you have to be uniquely identified.  And who "owns" that data?  Today most clinics and hospitals think rightfully so that they own your information.  They collect and store and protect it.  They use it just to provide services and to get paid.  Why would you, the lowly patient, have any rights to it?

And so if Obamacare gets involved, then who owns the data about your infectious disease or abortion records?  Its the same folks that own your tax filings, your criminal records, etc.  If they choose something like a SSN for the identifier, then they can easily connect health info with a broad range of financial activity and even work history.  Now if that's not something to cause concern for a thinking person, nothing is.

Week before last, I posted questions about these privacy issues on the White House web site where you can ask questions about the new plan.  My question was whether any government plan would be bound by the same privacy laws like HIPAA that apply to private, commercial healthcare providers and payers.  Today, most government agencies, like the VA health care systems, are exempted from these rules. 

Its been two weeks and I've had no response to my query.  My guess is Uncle Sam hasn't had time to think any of these privacy issues through.  Maybe some others need to start raising the question.